Shift to Safer Overactive Bladder Drugs for Women

A new study suggests that more women are being prescribed beta-3 agonists over anticholinergics for the treatment of overactive bladder (OAB), suggesting that more clinicians may be choosing this safer option for women. 

The study, presented at the American Urogynecologic Society (AUGS) PFD Week conference in Washington, DC, analyzed prescriptions for OAB medications at two large academic care centers between January 2020 and December 2022. During this period, 12,162 women were newly prescribed OAB medications, with 35.6% receiving beta-3 agonists and 64.4% receiving anticholinergics. 

Beta-3 agonist prescriptions increased by approximately 137% over the 3-year period, the researchers found. This shift appears to be driven primarily by urogynecologists, who were more likely to prescribe beta-3 agonists compared with other specialists, the study found. 

“However, anticholinergics still accounted for nearly two thirds of all prescriptions,” said Sarah Ashmore, MD, a fellow in the section of urogynecology and reconstructive pelvic surgery in The University of Chicago, Chicago, and lead researcher. 

This trend is particularly concerning given the growing evidence linking anticholinergic medications to cognitive impairment, especially in older adults.

AUGS updated its clinical consensus statement in 2021, advising about the risk for cognitive impairment associated with anticholinergics. The statement recommended decreasing anticholinergic burden in patients with OAB and considering beta-3 agonists when possible. It also advised against prescribing anticholinergics to women over age 70. 

Primary care clinicians emerged as the leading prescribers of OAB medications, accounting for 32.8% of all prescriptions. However, they were also more likely to prescribe anticholinergics compared with other specialists, the study found. 

“Urogynecologists were more likely to prescribe beta-3 agonists and then primary care clinicians were more likely to prescribe anticholinergics,” said Ashmore. 

Beta-3 agonists were more frequently prescribed to older women, White women, and those with government insurance, according to the study. Black women were disproportionately prescribed anticholinergics, with 83.2% receiving these medications compared with 50.8% of White patients.

The findings suggest that while there has been a positive shift towards safer medication options, there is still significant room for improvement in OAB treatment practices, especially among primary care providers, Ashmore said. 

“We really need more studies to look at these [overactive bladder] prescribing patterns on national databases and looking at national patterns,” she said. 

Ashmore also called for “studies to look at the motivation behind these prescribing patterns given the risk of cognitive impairment with anticholinergic pharmacotherapy.”

The study researchers reported no relevant disclosures. 

Lara Salahi is a freelance journalist living in Boston.